Examination of Eye

Examination of Eye - Copy of Lecture taken by Dr. Sanjay...

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Unformatted text preview: Copy of Lecture taken by Dr. Sanjay Shrivastava Dr. Professor of Ophthalmology Gandhi Medical College, Bhopal (M.P.) Examination of Eye Examination Dr Sanjay Shrivastava December 24, 2011 2 Examination of Anterior Segment Examination Examination of Posterior Segment Examination Dr Sanjay Shrivastava December 24, 2011 3 Examination of Anterior Segment of Eye Examination 1. • Examination of Vision Assessment of visual function Forms of visual perception are form Forms sense , the field of vision, the light sense and the colour sense, these senses are checked with Dr Sanjay Shrivastava December 24, 2011 4 Examination of Eye Examination • • • • • Visual Acuity Visual field examination with confrontation test, Visual perimetry (kinetic and static) perimetry Dark adaptation – measurement of least Dark luminance required to produce a visual sensation Contrast sensitivity – is measurement of the Contrast smallest distinguishable contrast ,it is assessment of quality of vision assessment Colour vision –with lantern test (Edridge green Colour lantern) and Isochromatic charts Dr Sanjay Shrivastava December 24, 2011 5 Visual Acuity Visual • • • • DefinitionIt is defined as the measure of the smallest It retinal image which can be appreciated with reference to its shape and size .it is actually measure of form sense. measure Subjective examination of the function of eye Subjective Central or direct vision Central Distance vision with Snellen test type Near vision with Snellen test type or Jaeger’s test type Dr Sanjay Shrivastava December 24, 2011 6 Visual Acuity Visual The principal of assessment is The measurement of spatial resolution of the eye i.e. an estimation of ability of eye to discriminate between two points. DISTANCE VISION Two distance point can be visible as separate only when they subtend an angle of 1 minute at the nodal point of eye. Dr Sanjay Shrivastava December 24, 2011 7 Snellen chart Snellen Principle Principle • • Each individual letter subtends an angle of 5 Each minutes and each component of letter subtends an angle of 1 minute at the nodal point of eye from the distance in meters written as numerical. from Snellen chart is having different number of Snellen letters in different rows and the letter at top line should be read clearly at distance of 60 m. similarly the letters at subsequent lines as are read at 36, 24,18,12,9,6,5mts respectively Dr Sanjay Shrivastava December 24, 2011 8 Snellen Chart Snellen Chart Snellen Chart Snellen Chart Snellen Chart Snellen Chart Trial Frame Trial Frame Occluder and Pin Hole Occluder and Pin Hole Snellen chart Snellen Numerical convention is used for recording Numerical visual acuity. In fraction, the numerator is the distance at which the patient is sitting from chart and the denominator is the distance at which person (with normal vision) should be able to read the last line that person is able to read. that Dr Sanjay Shrivastava December 24, 2011 14 Procedure of testing Procedure • • Patient is seated at the distance of 6 meters Patient from Snellen’s chart (distance of 6 mts is taken as at this distance it is assumed that the rays are almost parallel and patient exert minimum accommodation) accommodation) The chart should be properly illuminated at The minimum of 20 feet candles. Patient made to wear trial frame. It is adjusted according to patient inter pupillary distance. patient Dr Sanjay Shrivastava December 24, 2011 15 Procedure of testing Procedure • • • Ask the patient to read with one eye from the top Ask letter while the contra lateral eye is closed gently with the patient arm or with occulder in the trial frame. Now patient is asked to reads the Snellen’s chart Now and depending upon the smallest line which the patient can read from distance of 6mts his vision is recorded as 6/6, 6/9 ,6/12,6/18, 6/24, 6/36, 6/60. recorded But if patient is not able to see the top line from 6mts But he is asked to come towards Snellen’s charts step by step and vision recorded at 5,4, 3, 2, 1 mts and noted as 5/60,4/60,3/60,2/60,1/60 respectively Dr Sanjay Shrivastava December 24, 2011 16 Occluder Occluder Procedure of testing Procedure • • If patient is not able to read top line even at the If distance of 1 mts he is asked to count fingers of examiner and his vision is recorded as CF3FT, CF 2FT, CF1FT OR CF close to face . If patient not able to count examiner finger close If to face then examiner waves or moves his hand and asks patient whether he is able to see hand movement or not. Visual acuity then recorded as HM+ HM+ Dr Sanjay Shrivastava December 24, 2011 18 Procedure of testing Procedure • • When patient cannot distinguish hand When movements the examiner notes whether the patient can perceive light (PL) or not. If he perceive light it is noted as PL +ve otherwise as PL-ve. Also examiner then throw the light from four directions (nasal, superior, temporal, inferior) and record accordingly. if present patient and perceive light from all directions it is marked as PR (Projection of rays ) present or else mark as absent or defective. The test is repeated for the other eye in similar fashion repeated Dr Sanjay Shrivastava December 24, 2011 19 Procedure of testing Procedure English, Hindi and regional language charts Landolt ring chart Landolt This is the chart containing a series of broken rings, with each gap subtending an angle of 1 minute at nodal point at a given distance. It is used in illiterate patients. It E-chart – used in illiterate patients E-chart Simple picture charts for children. Dr Sanjay Shrivastava December 24, 2011 20 Procedure of testing Procedure • • Pin hole test Pin Method After noting vision unaided patient is asked to After read Snellen’s chart while holding a pin hole (hole size is 1mm) exactly in centre of pupil in front of eye. Now patient’s vision is noted and similar pin hole Now vision is recorded for other eye also Dr Sanjay Shrivastava December 24, 2011 21 Pin Hole Pin Hole Pin Hole Test Pin • • • Interpretation Interpretation If patient vision is improved with pin hole it If means the poor acuity is due to refractive error. If static acuity means may be due to structural or If organic cause. organic If reduced the poor visual acuity may be due to If corneal opacity or lenticular opacity occupying papillary area or macular pathology. Near vision Near Charts for testing near vision are Charts 1) Snellen near vision chart 2) Jaeger chart 2) 3) Roman test type 3) Dr Sanjay Shrivastava December 24, 2011 24 Near Vision Chart Near Vision Chart Method of recording Near vision Method Ask the patient to sit with his back to the light Ask If the patient is using glasses for distance the If same number will be put on the trial frame. Occlude one eye with an occulder Ask the patient to hold the near vision by his Ask right hand at a distance of 25 to 33 cms. right Note the near vision as per the letter read Repeat the test for the other eye. Repeat Dr Sanjay Shrivastava December 24, 2011 26 Examination of head posture Examination • • • • • • Position of head, face and chin should be noted. Note for elevation/depression of chin Note Note for any elevation or depression of head Face turn to right or left Face In complete Ptosis (chin is elevated to uncover In the papillary area in a bid to see clearly) the In paralytic squint (head is turned in direction of In action of paralyzed muscle to avoid diplopia). action Dr Sanjay Shrivastava December 24, 2011 27 Blepharophimosis Syndromen note chin elevation Blepharophimosis Examination of forehead Examination • • • Look for increased wrinkling (due to over Look increased action of frontalis muscle) in patient with Ptosis. Ptosis. Complete loss of wrinkling in one half of the forehead is observed in patient with lower motor neuron type of facial palsy (seventh nerve palsy). (seventh Facial asymmetry may be noted in Facial patient with bell’s palsy, musculo-facial anomalies and facial hemiatrophy. anomalies Dr Sanjay Shrivastava December 24, 2011 29 Examination of eye brows Examination Level of the two eyebrows may be changed in a patient with Ptosis (due to over action of frontalis) over Madarosis -Cilia of lateral one third of eyebrows may be absent in patient with leprosy and Myxoedema. leprosy Scarring in and area around eyebrow Scarring should be noted should Dr Sanjay Shrivastava December 24, 2011 30 Examination of the eyeball Examination Observe the following points Observe • Position – normally the two eyeball are symmetrically placed in the orbit in such a way that a line joining the center point of superior and inferior orbital margins just touches the cornea Dr Sanjay Shrivastava December 24, 2011 31 Examination of the eyeball Examination a) Abnormality of the position eyeball can be – a) Abnormality Proptosis /exophthalmos – buldge of the eyeballs –note whether proptosis is –axial or eccentric whether Reducible or non reducible Pulsatile or non pulsatile Enophthalmos – (sunken eyeball) Absence of eye ball (clinical) is called Anophthalmos. Anophthalmos. Proptosis Proptosis Shrunken (Small) eye ball Shrunken (Small) eye ball Shrunken (small) eye ball Shrunken (small) eye ball Sunken Eye Ball Sunken Eye Ball Examination of the eyeball Examination b) Visual axis of eyeball b) Normally the visual axis of the eyeball is Normally simultaneously directed at same object which is maintained in all the directions of gaze. Deviation is the visual axis of one eye is Deviation called squint. called Dr Sanjay Shrivastava December 24, 2011 37 Convergent Squint Convergent Squint Examination of the eyeball Examination c) Size of eyeball c) Measurement of eye is made by Measurement ultrasonography (A-scan) ultrasonography Size of eyeball is increased in conditions like Size buphthalmos and unilateral high myopia. buphthalmos Size of small sizes eyeball are-congenital Microphthalmos, phthisis bulbi and atrophic bulbi Dr Sanjay Shrivastava December 24, 2011 39 Examination of the eyeball Examination d) Movement of eye ball The movement are tested uniocular The (duction)as well as binocularly (versions) in all the six cardinal directions of gaze. in Uniocular – Adduction, abduction, Uniocular depression, elevation, depression and elevation in adduction and abduction Binocular Binocular Dr Sanjay Shrivastava December 24, 2011 40 Examination of the eyeball Examination Binocular Ocular Movements Binocular 3 3 4 5 4 5 1 2 1 2 6 7 8 6 7 8 Right side Left side 1 = Dextroversion; 2 = Levoversion; 3 = Elevation; Dextroversion; 4 = Dextroelevation ; 5= Levoelevation; 6= Dextrodepression; 7= Depression; 8 = Levodepression Dr Sanjay Shrivastava December 24, 2011 41 ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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